Free Essay About The Cardiovascular System
As part of the physical examination, a health care provider will assess the heart’s functioning and the blood flow throughout the body. The practitioner will listen to two heart sounds, S1 and S2 (Jarvis). S1 signals the beginning of systole while S2 signals the closure of the semilunar valves and the end of systole. These two heart sounds are normal and are found in every individual. Certain individuals may have extra heart sounds (Jarvis). S3 can be heard in young children, pregnant women, and individuals with heart failure (McCance, Huether, Brashers, & Rote). S4 is heard in individuals with heart decompensation (McCance, Huether, Brashers, & Rote). The health care provider might also listen to the frequency, intensity, duration, and timing of the beats (Jarvis). In addition to listening to the sounds, the practitioner will also listen to the two valves within the heart, the tricuspid and bicuspid valves, to make sure they are shunting blood properly through the heart (Jarvis).
After listening to the heart, the practitioner will listen to the lungs in all five lobes, two on the left and three on the right, to make sure there is adequate oxygenation occurring (Jarvis). There are three normal breath sounds that are heard on auscultation: bronchial, bronchiovesicular, and vesicular. Each sound is heard over different parts of the lungs (Jarvis). The provider will also assesses for abnormal breath sounds, which can indicate infection, collapse, and other abnormalities (McCance, Huether, Brashers, & Rote). If these abnormalities are present, the blood being received from the heart will not adequately be oxygenated and fail to provide the body with the appropriate oxygen level (McCance, Huether, Brashers, & Rote).
After the assessment of the heart and lungs, the health care provider will examine the peripheral pulses to make sure the blood is making its way throughout the body (Jarvis). In the upper extremities, the practitioner will palpate for the brachial pulse on the inside of the elbow, and the radial pulse, on the outside of the write beneath the thumb. In the lower extremities, the practitioner will palpate for the femoral pulse, on the inside of the hip where it meets the core of the body, the popliteal pulse on the back of the knee, the posterior tibialis on the inside of the ankle above the protruding medial malleolus bone, and the dorsalis pedis on the top of the foot between the big and second toe. The pulses are graded on a scale of 0 to 4+ based on the amplitude upon palpation. Zero indicates an absent pulse, 1+ is a weak pulse, 2+ is a normal pulse, 3+ is a full pulse, and 4+ is a bounding pulse (Jarvis).
While assessing for the peripheral pulses, the practitioner will also note the color, temperature, and skin turgor of the extremities as well as the capillary refill of the nail beds (Jarvis). The color of a health individual will be appropriate to their ethnic background with no signs of cyanosis, or decreased blood flow. The temperature of the extremities should be warm, indicating blood flow. Skin turgor indicates the hydration of the skin’s tissues. A normal response is skin that bounces back from being pulled upward. This is typically done on the back of the hands but encouraged to be done over the chest in an elderly patient. Lastly, capillary refill is assessed at the nail beds of the hands as well as the feet. It indicates good blood flow if the nail bed, after being pressed lightly, returns to pink within 2 seconds. If there is no change in color or the color does not return to pink, there is decreased blood flow to the digits (Jarvis).
If there is decreased blood flow, specifically to the coronary arteries that supply the heart, an individual will experience angina (McCance, Huether, Brashers, & Rote). There are different types of angina, depending on the severity of the situation. Stable angina is caused by the narrowing and hardening of the arterial walls, obstructing the flow of blood. It is typically felt within the chest and may be mistaken for indigestion. The pain is a result of the irritation of the myocardial nerve fibers. This pain may radiate to the neck, lower jaw, and left arm and may be accompanied by pallor, diaphoresis, and dyspnea. The pain may be alleviated with nitrates and rest. Unstable angina, unlike stable angina, occurs more often, more severe, and without a pattern. It can occur with or without physical exertion. It may not be relieved with medicine or rest and requires emergency treatment. Prinzmetal’s (Variant) angina occurs when the coronary artery spasms. This type of pain occurs at rest, usually during the middle of the night, and can be relieved with medications (McCance, Huether, Brashers, & Rote).
After the examination, the practitioner will record the finding in a SOAP note. If a patient comes to the doctor’s office or hospital, he or she may have a complaint of chest pain or shortness of breath, which will be recorded in the Subjective section. Next, the examiner will record his findings in the Objective section. From the examination, the practitioner will make a medical diagnosis which will be recorded under assessment. Lastly, a plan will be devised to help restore the health of the individual and this will be recorded under the Plan section. The following is an example of a SOAP note:
John Doe is a 53-year-old male machinist admitted to the CCU at Community General Hospital (CGH) with chest pain.
Patient states he is having chest pain radiating to the L shoulder, accompanied by nausea,
vomiting, and diaphoresis. Patient states he has a positive history of high blood pressure, hyperlipidemia, and DM II.
Family hx—mother died of MI at age 57.
Personal habits—smokes pack cigarettes daily × 24 years, no alcohol, diet—trying to
limit fat and fried food, still high in added salt.
Skin is pink, with no signs of cyanosis. Upper extrem.—capillary refill sluggish, no
clubbing. Lower extrem.—no edema, no hair growth 10 cm below knee bilaterally.
Pulses— carotid 2+, brachial 2+, radial 2+, femoral 2+, popliteal 0, posterior tibialis 0
B/P R arm 150/100 mm Hg
Neck: External jugulars flat. Internal jugular pulsations present when supine and absent
when elevated to 45°.
Auscultation: Apical rate 92 bpm regular, S1-S2 are normal, not diminished or
accentuated, no S3 or S4, grade iii/vi systolic murmur present at left lower sternal border.
Substernal chest pain
Ineffective tissue perfusion R/T interruption in flow
Decreased cardiac output R/T reduction in stroke volume
Possible MI. ECG, full blood panel ordered. Possible cardiac catheterization to follow.
Adjust medications and nutrition and exercise counseling.
Jarvis, C. (2012). Physical examination & health assessment (6th ed., p. 164). St. Louis, Mo.:
McCance, K., Huether, S., Brashers, V., & Rote, N. (2014). Pathophysiology: The biologic basis
for disease in adults & children (7th ed., p. 1626). St. Louis: Mosby.